Provider Demographics
NPI:1548243371
Name:LUBETSKY, KENNETH ROY (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROY
Last Name:LUBETSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 GIDNEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3116
Mailing Address - Country:US
Mailing Address - Phone:845-561-5452
Mailing Address - Fax:
Practice Address - Street 1:450 GIDNEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3116
Practice Address - Country:US
Practice Address - Phone:845-561-5452
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0302401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice